title: Barriers to colorectal cancer screening among women in rural central Pennsylvania: primary care physicians' perspective.
abstract: BACKGROUND
  Colorectal cancer (CRC) is the third leading cause of death among women in the USA. Rural populations have lower rates of CRC screening than their urban counterparts, and rural women have lower screening rates compared with rural men. The purpose of this qualitative study was to identify (1) beliefs of primary care physicians (PCPs) about CRC screening in rural communities, (2) factors that may cause gender disparities in CRC screening in rural areas, and (3) solutions to overcome those barriers.
  
  
  METHODS
  Semi-structured interviews were conducted with 17 PCPs practicing in rural central Pennsylvania. PCPs were asked about their CRC screening practices for women, availability of CRC screening services, reminder systems for CRC screening, and barriers to screening specific to their rural communities and to gender. Thematic analysis was used to identify major themes.
  
  
  RESULTS
  All 17 PCPs endorsed the importance of CRC screening, but believed that there are barriers to CRC screening specific to women and to rural location. All PCPs identified colonoscopy as their screening method of choice, and generally reported that access to colonoscopy services in their rural areas was not a significant barrier. Barriers to CRC screening for women in rural communities were related to (1) PCPs' CRC screening practices, (2) gender-specific barriers to CRC screening, (3) patient-related barriers, (4) community-related barriers, and (5) physician practice-related barriers. Physicians overwhelmingly identified patient education as necessary for improving CRC screening in their rural communities, but believed that education would have to come from a source outside the rural primary care office due to lack of resources, personnel, and time.
  
  
  CONCLUSIONS
  Overall, the PCPs in this study were motivated to identify ways to improve their ability to engage more eligible patients in CRC screening. These findings suggest several interventions to potentially improve CRC screening for women in rural areas, including encouraging use of other effective CRC screening modalities (eg fecal occult blood testing) when colonoscopy is not possible, systems-based reminders that leverage electronic resources and are not visit-dependent, and public health education campaigns aimed specifically at women in rural communities.
authors.affiliation: Penn State College of Medicine, Hershey, Pennsylvania, USA. lrosenwasser@hmc.psu.edu.
authors.forename: Lara A
authors.initials: LA
authors.lastname: Rosenwasser
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McCall-Hosenfeld
authors.forename: Carol S
authors.initials: CS
authors.lastname: Weisman
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Hillemeier
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Perry
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D010465:Perception; D058007:Physicians, Primary Care / Q000523:psychology*; D012424:Rural Population; D012737:Sex Factors; D016387:Women's Health